Die Once Live Twice

by Lawrence Dorr

  After he looked one more time at the mother, at Angelo, and at Jonathan, Doctor Park slid the needle into Angelo’s skin and injected the liquid into the muscle. The boy started, but Jonathan gently held his arm still. As he withdrew the needle, Doctor Park looked at Jonathan with the smallest smile. He knew the consequences if the boy died, but if he lived it would be the first cure ever of a disease in the United States. Jonathan suddenly realized that he was present at what could be a monumental change in the course of medical history—hell, he thought, in all of history!

  Jonathan couldn’t believe his luck to be here today to watch medicine take this giant leap. After earning his medical degree from Harvard he went to Hopkins and worked in Welch’s laboratory for one year. His focus was isolating bacteria and studying chemicals to kill them. Welch sent him to New York. “Jonathan, you need to learn all you can about bacteriology. Bacteria are our greatest foe. One of bacteriology’s shrewdest warriors is Doctor Herman Biggs, chief of the Health Department for New York City.”

  Jonathan soon learned that Biggs was the most decisive man with whom he had ever worked. When a cholera epidemic threatened New York City in 1892, Biggs had the ghetto streets and lots cleaned, scoured thirty-nine thousand tenement buildings and flushed out their water pipes with disinfectant. Circulars were distributed about prevention and treatment in English, German, French, Spanish, Italian, and Yiddish. The epidemic was stopped dead in its tracks. Now Biggs was at war with diphtheria, the winter-time murderer of children. It started with a sore throat and low fever, but progressed to nausea, vomiting, chills, and often, finally, the lethal membrane in the throat or nose. Biggs hired Park to set up a bacteriology laboratory specifically for diphtheria cases, the first in the United States.

  Diphtheria was cured first in Europe. Emil von Behring had inoculated a boy on Christmas Eve, 1891, saving his life. At a medical meeting in Budapest in May 1894, Biggs heard Emile Roux present data that fifty-six percent of sick children given the diphtheria antitoxin lived, while seventy-five percent of those without the antitoxin died. Biggs joined other doctors as they threw hats in the air and stood on chairs and clapped. Finally. Finally doctors could really make a difference. Biggs rushed from the hall, telegraphed the news to Park, and ordered him to initiate the process to inoculate the children of New York City. Jonathan was right where he wanted to be—in the middle of finding a cure for infection.

  Park and Jonathan were quiet as they walked back to the office in the basement of the building at 42nd and Bleecker. As they entered, Biggs was waiting anxiously. He grabbed Park by the arm. “Well,” he blurted. “How many are inoculated?”

  “One.”

  “Only one? My God, we rolled all the dice on one patient?” Biggs sat down and stared at the floor. Park explained the difficulty, which was not entirely news to Biggs, but he had hoped for at least ten children to give them a sure chance of success. “You know the percentages are not one hundred, William. If that boy dies...”

  “If he dies, we will keep trying,” Park said firmly. “You’re right, Herman, I do know the percentages, and I know that they are in our favor. The antitoxin works. Not every time, but most of the time. Medicine has joined forces with experimental science now. We’re not just hoping.”

  Biggs sighed. “You’re right, of course, William. But sometimes I wish we had a magic wand. If we can just replicate the results of von Behring and Roux, we will be... we’ll save a lot of lives.”

  Jonathan went home for the night to his apartment in the Bowery. Tomorrow would be a momentous day, he felt sure. His hard work was coming to fruition. He only wished his mother were here to share his exhilaration. She had died in the fall of 1894, soon after she visited him in New York City. Her strength was on the wane and her weight was falling, but her spirit was strong. She visited the laboratory with Jonathan and watched every step of the antitoxin process. They had converted the clean laboratory out of a horse stable.

  “Why horses?” asked Katherine.

  “Because the blood serum of horses doesn’t provoke a violent reaction in children—it is tolerated well. I complained at first, Mother. I didn’t want to be a stable boy. I didn’t know how we would buy horses or where would we house them. I knew there was little money in the budget. Well, Parks laughed at me and said, ‘There’s no money for wealthy medical students, but when it comes to horses—your job is to answer your own question. I’ll give you $500 to buy the first five horses. You find a clean stable to house them.’ That was the beginning of this strenuous summer.”

  Jonathan found a veterinary college on East 72nd Street where he could house the horses. When Biggs returned, he loaned them his own money to start buying more animals and then cajoled the New York Herald newspaper into raising $8,000 dollars for sixty horses. Jonathan named the stable the Royal Palace for Horses, because Park insisted that it remain absolutely clean and as sterile as possible. Any infection in the horses’ serum would be passed to the children, so the walls and floors were scrubbed twice a day, manure was immediately removed, and flies and rats were eradicated. The horses were given only clean, filtered water, free of cholera or typhoid bacteria, and feed that was free of dirt and debris. “I have to inspect their meals like I’m the king’s taster,” Jonathan complained good-naturedly. Jonathan dressed neck to toe in a long sterile gown and wore a hood that covered his head entirely, exposing only his face, which was covered with a mask. The room used was thoroughly washed, floor to ceiling, ten minutes before the procedure. “Dust will not fly around in a wet room,” Park explained. “The particles will stick to the walls for the time it should take you to remove the serum from the flasks.”

  Jonathan quickly learned how to expose a horse’s jugular and insert a large open-ended needle in the vein, which drained blood into flasks through a sterile rubber tube. Each horse could safely fill nearly twenty flasks, and horses were rotated as donors to allow them to replenish their blood. Within minutes of being collected the blood began to clot, attaching itself to the walls of the flasks that were stored on their sides. The serum separated from the clotted blood, creating a yellow, liquid layer that was transferred into glass vials to be used for injection.

  Katherine was fascinated. When Jonathan explained the high costs, she ran a personal fundraising campaign for this project while in New York. She hosted a dinner at the Waldorf-Astoria for Teddy Roosevelt, General William Waring, and John D. Rockefeller. Roosevelt was reforming the police and raided corrupt police stations and bars wielding his own pistol; Waring was manager of New York’s sanitation and treated the city’s filth as a wartime enemy. Waring’s White Angels swept away refuse and manure, both sources of disease. By evening’s end, all three pledged their support to the project’s success. As they left, Jonathan saw Rockefeller leave his legendary dime for a tip. It’s not worth what it used to be, he thought. Katherine left the dinner secure that Biggs would have the support of the power in New York City.

  Katherine never knew whether Jonathan’s project succeeded, but she died at peace with herself. She was grateful for the gift of time she’d received, for she knew no one else had lived six years with breast cancer. She had been consumed by her passion to leave the earth a better place, pressuring medical research to improve and find treatments to prolong life. Life expectancy of less than fifty years was just too short. A way to prolong life had been found for patients with breast cancer. Her sons, and future heirs, would build on her legacy and be responsible for the discoveries that would eliminate disease as man’s scourge.

  Chapter Seventeen

  CURES

  Jonathan had butterflies as he walked with Park to Angelo’s house the next morning. He had felt this nervous excitement before football games, but those were games for entertainment. This was life and death. If they lost, there wasn’t another chance the following Saturday. All the months of work now came down to the health of one small child.

  He walked with fear in his heart—the fear of failure compounded by the fea
r of retribution. Park asked the neighborhood constable to accompany them and stand outside the tenement house. As they knocked on the tenement door in the strangely quiet hallway, Park looked at Jonathan and took a deep breath. “No one has assailed us yet,” Jonathan said encouragingly. Park nodded and knocked again. When it opened, Angelo’s mother Lucia immediately began crying and Jonathan’s heart sank. Then she startled both of them by grabbing Doctor Park’s hand and kissing it. Park looked at Jonathan, his eyebrows raised, as the woman pulled him into the room by his arm to see Angelo. The boy was lying on a thin mattress on the floor, breathing normally, and when he looked up at them, he smiled.

  Jonathan had heard of seminal moments in life. This must be one, he thought. No football game, no date, not graduation from medical school—nothing had given him the surge of emotion he felt throughout his body.

  Park leaned forward and laid a hand on the boy’s forehead. His smile broadened as he straightened up. “His fever has broken. It worked, my boy, it worked.” He clapped Jonathan on the back.

  “Cured!” Jonathan grabbed the doctor’s hand and shook it vigorously. “A new age in medicine. Hell, a new age for society!”

  Lucia gestured at Park’s medical kit. “How...?” she asked, then stopped, not having the words. Park and Jonathan combined their meager knowledge of Italian with the woman’s equally meager knowledge of English in an effort to explain. Park held up a vial of the serum. “In this, there are antibodies”—Lucia frowned—“like soldiers, soldati, to fight the disease. We put the soldiers in Angelo’s blood—”

  “Sangue,” Jonathan said helpfully, and Lucia nodded.

  “—and the soldiers kill the disease.”

  Lucia smiled and nodded again. “Sono forte, questi soldati,” she said, making a fist.

  Doctor Park laughed. “Yes, very strong.”

  There was a knock at the door, and Jonathan turned to see a crowd of women holding children. It was clear that they now wanted the vaccination, too, and Doctor Park had brought it with him hoping for just such an outcome. Before they left, word spread around the neighborhood and more women came for what they called magic. With each injection he gave that afternoon, Doctor Park thanked God, the European doctors who discovered the antitoxin, and Biggs, for being in Budapest.

  For Jonathan, it was the moment he came to know who he would be. Each person must learn their purpose, must have an epiphany like this, to understand the meaning of their life, he thought. He now knew his work was to learn the secrets of germs so he could destroy them. God, could it be possible that this glory was to be his? Was he indeed a Richard the Lionheart whose crusade was infection? His mother had believed it, and now so did he.

  Jeffrey had his moment of enlightenment when Welch convinced him that medical education was his career. In 1897 he was within months of becoming a doctor of medicine in the first graduating class of Johns Hopkins. His favorite teacher was Doctor Harvey Cushing, who arrived in 1896 from Harvard as a first-year resident studying with Halsted. Jeffrey was the first medical student to work with him.

  In their first surgery with Halsted, Cushing was fidgety. “Why can’t you stand still?” Jeffrey whispered.

  “This patient will die. He takes forever to operate.” Halsted’s meticulous method of ligating every bleeder minimized blood loss and shock, so he sometimes operated five hours. “At Harvard the skill of the surgeon was judged on the speed of his operation,” Cushing continued.

  “Didn’t you have anesthesia?” Jeffrey whispered back.

  “Yes, but that hasn’t changed the surgeon’s habits.”

  “You have a lot to learn, Harvey. At Hopkins the doctors make decisions and act based on research and knowledge, not past tradition. This is a very different place.”

  Jeffrey and Cushing studied and learned together. Cushing had a deep interest in the brain and neurological system. Roentgen’s x-ray had been available for two years, and both young men were fascinated by what they could learn by seeing inside the body. One evening in 1897 they were studying the x-ray of a gunshot wound to the neck, marveling at how the bullet had shattered the structure of the third and fourth cervical vertebrae. Cushing suddenly pushed back his chair and ran doubled over out of the x-ray room. Jeffrey followed him to the restroom, where he watched him kneel over the sink and vomit.

  “What’s the matter?”

  “I’m not sure. I’ve had a pain in my lower abdomen all day. Now I have trouble standing up straight.”

  “Lie down on the floor,” Jeffrey commanded. The lower right side of Cushing’s abdomen felt tense and he yelped when Jeffrey pushed on it. When Jeffrey quickly released his push, Cushing screamed.

  “That’s rebound tenderness,” Jeffrey said. “You have appendicitis, Harvey. Rebound tenderness is the classic sign of this infection.”

  “Appendicitis?”

  “In Boston you may have called it peri-typhlitis. Doctor John Murphy in Chicago presented fifty cases, operated on the patient’s kitchen table no less, to his medical society. They booed him out of the building. But Halsted believed him. He operates for these symptoms you have.” Jeffrey helped Cushing to a bed in the hospital and ran to find Halsted. If the appendix burst, the bacteria would spread through Cushing’s body and then there was no treatment. He would die.

  Halsted confirmed the diagnosis, and within the hour Cushing was on an operating table, his abdomen prepared with carbolic acid and permanganate while he was anesthetized with chloroform. Halsted worked steadily, clamping and tying each bleeder, until he could see the appendix. “It is that fingerlike appendage from the colon,” he said to Jeffrey. “Not quite as big as your little finger usually, but today it is, being so swollen.” Halsted ligated the root of the appendix and then amputated it and sewed the defect in the bowel.

  He lifted up the clamp that held the appendix and all in the room stared at it. “Cured!” was all he said.

  Jeffrey was witness to the first surgical operation that cured a disease—the removal of an infected appendix—and experienced a transcendent moment, as had Jonathan with the medical cure. It fueled his passion for medicine, which he had tolerated until now for his mother’s sake. Now he had witnessed what he’d always said doctors couldn’t perform—a cure. Medicine became his profession. He wrote to Jonathan:

  Dear Jonathan,

  You are no longer the only doctor who has witnessed a cure. Today I watched a surgical cure, by removal of an infected appendix. Because you are a Harvard man you probably know it by that uneducated name of peri-typhlitis! It can be done! Medical cures are by chemicals and surgical cures are by cutting out disease. Wouldn’t Mother be excited! We are on the road to Jerusalem, and I will serve the cause by educating your soldiers as you search for Medicine’s Holy Grail.

  Your brother,

  Jeffrey

  Chapter Eighteen

  JONATHAN THE LION

  A maroon and tan Great Arrow motorcar, latest 1907 model, stopped in front of the Fifth Avenue entrance of the new Plaza Hotel in New York City. A tall blonde woman with large shoulders and chest, her hair fashionably twirled into a bun, stood up in the seven-foot-tall car. She took the doorman’s offered hand and stepped down from the passenger side. Jonathan Sullivan exited from the driver’s seat. As he removed his Borsalino fedora and took the woman’s hand, the doorman asked, “Mrs. Sullivan, isn’t it rather cool to ride in an open touring car in November?” “Ask cockle-brained Jonathan. I bundled up in this fur coat and fur hat to go six blocks. Now you know how much I must love him!” she said, taking Jonathan’s arm and snuggling up to him.

  Jonathan and Marion lived in one of the mansions on Fifth Avenue just above 65th Street, joining the Vanderbilts, Astors, and Andrew Carnegie, among others. Jonathan enjoyed his wealth. Their house staff of twenty cost him $25,000 a year. The two Great Arrow cars were over $8,000. Though far beyond what his $1,000 yearly salary as a doctor could buy, they were readily affordable on the $5 million income from investments of his $50 million
inheritance.

  Jonathan marched her up the stairs into the warmth of the lobby, nodding to those they knew. Marion Kramer Sullivan, a Broadway actress, was five foot seven and had Scandinavian blonde hair and blue eyes. Her cheek bones were high and her figure voluptuous, two characteristics that attracted Jonathan. Jonathan had met her in his private clinic at Rockefeller Hospital, the clinical arm of Rockefeller Institute.

  Jonathan’s appointment at the Rockefeller Institute when it opened in 1902 was a boost for his career, despite his initial reluctance. Welch had ordered Jonathan to move to Rockefeller to do research. “Rockefeller will become the leading center for study of infection in the world,” Welch had insisted. After the death of his three year-old son from scarlet fever, John D. Rockefeller had funded the Rockefeller Institute for Medical Research. When Jonathan objected that he didn’t want to leave his research with Park, Welch grudgingly said, “Well, you can keep your weekly clinic in the tenements with Doctor Park, but I warn you, Simon Flexner and Park are not friends.” Welch had selected Simon Flexner, his protégé and an outstanding pathologist, to head the research laboratories at the Rockefeller.”Jonathan, the money for research is at Rockefeller. Your self-proclaimed destiny can be achieved there, not working for the city of New York.”

  Marion came to Jonathan’s clinic because she wanted a smallpox vaccination. “I grew up in Des Moines, Iowa, and no one gets vaccinated back there. When I went to Philadelphia to perform in a week-long music festival, all I read were stories about a smallpox epidemic there.”

  “Yes,” Jonathan agreed. “Philadelphia is my hometown, but it has a disgracefully high rate of smallpox, and has since 1901. The river is full of filth, and until the new mayor came in and cleaned house last year, even the hospital was a source of infection.”

  “That’s why I came to Rockefeller,” said Marion. “Everyone told me not to get vaccinated in Philadelphia. Some people got tetanus from the vaccine.”